While we’re on vacation, we’re re-posting content from earlier in the year. This post was originally published on March 9, 2011.

By Celeste Monforton

“Death takes no holidays in industry and commerce,” is how Labor Secretary Willard Wirtz described the toll of on-the-job death and disability for U.S. workers. The Secretary’s remarks in 1968 were part of congressional hearings on legislation that ultimately established the Occupational Safety and Health Administration (OSHA). He suggested that because most work-related fatalities and injuries happen one or two at a time, day in and day out, the carnage continues

“because people don’t realize its magnitude, and can’t see the blood on the things they buy, on the food they eat, and the services they get.”

At the time, advocates of a strong federal worker safety law used the following figures to explain the scale of the problem: 15,000 fatal work-related injuries per year, along with another 7 million workers injured and 2 million disabled. Most recognized, however, the limitations in these estimates. A special report prepared in 1965 for the U.S. Surgeon General noted the absence of a comprehensive system for occupational injury and disease surveillance. The authors of “Protecting the Health of 80 Million Americans” wrote:

“it is almost inconceivable that this nation, with its vast resources and technical skills, has never developed a comprehensive picture of the work environment to determine the relationship with the health status of its productive work force.”

Several provisions of the OSH Act of 1970 were designed to fill some of those data gaps—at least in industries covered by OSHA—but the U.S. is far from having a comprehensive occupational injury and illness surveillance system. Through a series of post here at The Pump Handle, you’ll be introduced to our nation’s current methods for counting work-related injuries, disease and death among U.S. workers, and their limitations. You’ll be invited, as always, to share what you know about this topic and offer suggestions for other models, including those used abroad.

Surveillance: an integral part of public health practice

An ongoing, systematic collection and analysis of adverse health events is critical for sound public health policy making. We call it surveillance. There are several provisions in the OSH Act that reflect an appreciation by the bill’s authors for the value of occupational injury and illness surveillance—for planning, data dissemination, program implementation and evaluation. Specifically:
•Section 8(c)(1): Requires employers to keep records and make them available to US Departments of Labor (DOL) and Health and Human Services (HHS) officials such as records that could be used “for developing information regarding the causes and prevention of occupational accidents and illnesses.”

•Section 8(c)(2): Instructs DOL, in cooperation with HHS, to issue regulations for employers’ periodic reporting of work-related injuries and illnesses.

•Section 20 and Section 22: creates the National Institute for Occupational Safety and Health (NIOSH) within HHS, and authorizes it “to establish such programs of medical examinations and tests as may be necessary for determining the incidence of occupational illnesses…,” and “enter into contracts, agreements or other arrangements for the purpose of conducting studies relating to his responsibilities under this Act.”

•Section 23: allows DOL to make grants to State agencies to establish “systems for the collection of information concerning the nature and frequency of occupational injuries and diseases.”

•Section 24(a): instructs DOL, in consultation with HHS, to “develop and maintain an effective program of collection, compilation and analysis of occupational safety and health statistics.” DOL “shall compile accurate statistics on work injuries and illnesses…”

Early in OSHA’s history, the responsibility for collecting and analyzing occupational injury and illness statistics was delegated by the Secretary of Labor to DOL’s Commissioner of Labor Statistics. It would be the Bureau of Labor Statistics’ (BLS)) responsibility, not OSHA’s, for collecting and tabulating work-related injury and fatality statistics. In a 1971 order, Labor Secretary J.D. Hodgson said BLS was responsible for:

“…developing and maintaining an effective program for collection, compilation, analysis and publication of occupational safety and health statistics, and
making grants to States or political subdivisions thereof in order to assist them in developing and administering programs dealing with occupational safety and health statistics.”

BLS’s statistical program on worker injuries and death has evolved over the last 40 years. Currently, the bureau provides two key annual reports to fulfill these responsibilities: the Census of Fatal Occupational Injuries (CFOI) issued in August and the Survey of Occupational Injuries and Illnesses (SOII) issued in October.

Annual Count of Fatal Work-Related Injuries (but not Illnesses)

BLS provides grants to state agencies to compile data from a variety of sources on every work-related fatal-injury case occurring in the U.S. in a given year. They rely on death certificates, news media accounts, police reports, workers compensation records, fatality reports submitted to OSHA, the Mine Safety and Health Administration (MSHA), the National Transportation Safety Board (NTSB) and other federal agencies, and motor vehicle reports. For each fatality case, they attempt to confirm the information and its work-relatedness using at least three data sources, and may assemble as many as 30 data elements for each event, such as age of the worker, occupation, industry, and nature of the injury.

The census includes cases of worker deaths from the private and public sector (e.g., prison guards, fire fighters) but does not include U.S. workers killed overseas (e.g., military or U.S. contractors). The decedent had to be engaged in legal work activities (e.g., the death of a sex worker would not be included), and it makes no difference whether the worker was earning an hourly wage or salary, or was self-employed.

BLS instituted this census methodology in 1992, after worker safety, public health and policymakers identified severe shortcomings in a survey method used previously by BLS. Many deficiencies in the survey method were outlined in a 1987 National Research Council report entitled “Counting injuries and illnesses in the workplace: proposals for a better system.” The survey method was found to capture only about half the number of work-related fatal injuries. In 1990, the official count of work-related fatal injuries was 2,900, an estimated based on BLS’s survey method. In 1992, the first year using the new census model, the count of fatal work injuries was 6,217.

The most recent CFOI was issued in August 2010. BLS provided a preliminary fatality count for 2009 of 4,340 fatal occupational injuries. The lowest count in the census’ 17 year history. BLS’ final tally of fatalities is typically issued in April of the following year, frequently with a revised figure showing a couple of hundred more fatalities.

Although many people refer to the CFOI data as a worker fatality count, it’s wise to remember that the tally does not include fatalities caused by a work-related disease, such as asbestosis, hepatitis (e.g., in a health care worker) or certain cancers. BLS includes a small footnote on its lengthy data tables that says:

“CFOI does not count fatalities related to an occupational illness unless it was precipitated by an injury event,”

but this fact seems lost in many news accounts of the annual release of fatality data.

DOL and HHS’s failure to account in some way for occupational disease mortality and morbidity in our nation’s surveillance system is not a new problem. In 1984, the House Committee on Government Operations held a series of hearings on the Executive Branch’s inability to address occupational illness surveillance.

“Since the passage of the OSH Act nearly 15 years ago, a bipartisan failure of four administrations has thwarted the mandated development of an information and data collection system on occupational diseases. No reliable national estimate exists today, with the exception of a limited number of substance-specific studies (such as on asbestos), on the level of occupational disease, cancer, disability, or deaths. It cannot be meaningfully determined if diseases from chronic exposure to hazardous substances represents a greater problem today than when the OSH Act was passed in 1970. Such lack of reliable accurate data greatly hampers any broad-based evaluation of the OSHA program.”

The committee staff who authorized that indictment would find little has changed in this regard in the subsequent 25 years.

A surveillance system for occupational illnesses and deaths poses a number of challenges, including latency and multi-causality of diseases. These factors will be explored in the next installment in this series, along with estimates published by a number of colleagues on the magnitude of work-related disease and disability for US workers.

IMO the present system of reporting, insurance, and heath care prevent workers from getting health care. Employers have few incentives to report the full extent of injuries because that means insurance costs go up. Insurance companies have no incentive to promote accurate reporting because injuries unreported don’t have to be paid for by them. Employees don’t report because reporting means you get fired. Employees are encouraged to ‘work through the pain’. If they absolutely have to go to the ER the employer will tell them they didn’t get injured at work and he will pick up the bill on the side.

This almost always means the employer covers the ER visit but is unlikely to cover long term care, rehabilitation, or compensate the employee for the cost of having what is thereafter referred to as ‘a preexisting condition’.

Damn near everyone I know working construction has a constellation of nagging injuries they never quite got over because they either avoided medical treatment entirely, or the healing process was cut short. Of course, when the pain gets bad enough you can’t work. Unemployed, brake, and with several job related major preexisting conditions you can’t get insurance and few people will hire you.

It is a bit of a Catch-22. OTJ injuries are one of the best arguments for national health care. Employers who have worked in countries with NHC love being able to cross workman’s comp and healthcare off their bottom line and being freed of any need to sneak around injuries and reporting. Employees much prefer to work where they are not forced to ‘work through the pain’ or get by with half treatment. But the case can’t be made because everyone is invested in under-reporting OTJ injuries and job related health conditions.

It also makes your jobs, counting work-related injuries, disease and death among US workers, much more difficult.

Art, you’re right about the problems with the current system. National healthcare would at least solve the problem of injured workers not getting care, but it wouldn’t give employers an incentive to prevent injuries and illnesses.

If employers faced a good chance of getting caught and severely punished for underreporting, the practice might become less common.

Liz, Right now employers have an incentive to prevent injuries and illnesses, it hurts their bottom line. Having to train a new person, or losing hours of productivity to get a new person going is pissing money away compared to having a healthy worker. The current system provides a perverse incentive, making reporting illness bad for everyone, so no-one knows what is really going on. Once every work related illness,injury, and death is reported, figuring out what steps will help (people and the bottom line) the most is much simpler.

Just punishing employers for under-reporting wont remove the incentive that made them under-report in the first place.

Having a worker get injured might be bad for an employer’s bottom line, but employers often don’t know that, or they wildly underestimate the risk of an injury occurring. Some employers realize that prevention makes sense and invest in it, but many others don’t.

As far as the incentive calculation for injury reporting, right now employers can be fairly sure that they’ll see consequences for reported injuries – increased workers’ comp premiums, missing out on contracts that require low injury rates, etc. On the other hand, if they fail to report an injury, they’re unlikely to get caught and punished for it. Increasing the likelihood that employers who under-report injuries will be caught and severely punished will make under-reporting a less attractive course of action.

I was just thinking that figuring out ways to reduce the consequences for reporting injuries, especially for the companies that do the best job would be a more optimal solution. Having universal health coverage, not tied to the workplace, is something I think is a mandatory step in that direction. Until there is a less perverse worker compensation system everyone gains by gaming the system. People have a tendency to be really bad at balancing long term costs against short term benefits, and down right useless if the costs are hidden.

In the mean time, catching more cheaters, and punishing them is the only thing we can really do. My concern is that increasing the punishments will only cause companies to be better at hiding things. Perhaps some sort of amnesty where punishment is minimal, but accountability is established, for changing over to reporting things. Plus benefits to companies that have timely and complete reporting of injuries to give a short term incentive for a behavior that only has long term benefits at the moment.